Avshalom Caspi, Edward M. Arnett Distinguished Professor of Psychology and Neuroscience, Duke University, presents, “Charting mental disorders from childhood to midlife”
The practice of diagnosing mental disorders is at a crossroads. The Diagnostic and Statistical Manual of Mental Disorders (DSM), which provides guidelines for diagnostic practice, is being questioned, not just by the “anti-psychiatry” movement, but by detractors within the discipline itself. The U.S. National Institute of Mental Health, a major funder of mental health research internationally, has called for a new approach to studying mental illness, to be shaped by investigating research domains rather than by investigating traditional categorical diagnoses. And the public is confused about what constitutes a mental disorder, a confusion resulting in “diagnosis shopping”. My thesis is that progress in conceptualizing mental disorders has been delayed by the field’s limiting focus on cross-sectional information. Mental-health professionals typically encounter a patient at one point in his or her life. This cross-sectional view fosters a focus on the current presenting disorder(s), on the assumption that diagnosis informs about etiology and prognosis. But what happens outside the clinic, and what happens across development? I present new data from the most detailed study of mental-disorder life-histories ever assembled to show how mental disorders ebb and flow over the life course, from childhood to midlife. The data follow 1037 participants in the Dunedin Longitudinal Study, a birth cohort studied from birth to age 45 years. People who were diagnosed with one disorder and kept it were exceedingly rare. Rather, the predominant pattern was to shift over time among multiple different Internalizing, Externalizing, and Thought disorders. Life-history data from the present study inform a life-course perspective on mental disorders which cautions against over-reliance on diagnosis-specific research and clinical protocols. The finding that most mental-disorder life-histories involve different successive disorders helps to make sense of why contemporary genetic, neuroscience, and risk factor research is finding so many commonalities among different mental disorders, and it gives impetus to developing transdiagnostic prevention and treatment approaches.
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